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BJA Advance Access published online on April 4, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael082
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted March 7, 2006

Clinical Investigation

Preconditioning effects of levosimendan in coronary artery bypass grafting--a pilot study

L. Tritapepe 1, V. De Santis 1 *, D. Vitale 1, M. Santulli 2, A. Morelli 1, I. Nofroni 3, P. E. Puddu 4, M. Singer 5 {dagger}, and P. Pietropaoli 1

1 Department of Anesthesiology and Intensive Care, University of Rome ‘La Sapienza’, Rome, Italy
2 Department of Cellular Biotechnology and Haematology, University of Rome ‘La Sapienza’, Rome, Italy
3 Department of Experimental Medicine and Pathology, University of Rome ‘La Sapienza’, Rome, Italy
4 VOC di Biotecnologie Applicate alle Malattie Cardiovasculari, Department of the Heart and Great Vessels ‘Attilio Reale’, University of Rome ‘La Sapienza’, Rome, Italy
5 Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK

* To whom correspondence should be addressed.
V. De Santis, E-mail: vincenzo.desantis{at}uniroma1.it


  Abstract

Background. The calcium sensitizer levosimendan protects against myocardial ischaemia and reperfusion injury in animal models.

Methods. The present pilot study investigated whether a short infusion before coronary artery bypass grafting (CABG) would protect the myocardium and improve postoperative haemodynamics. Twenty-four patients with stable angina undergoing elective CABG surgery were randomized to receive either placebo or levosimendan (24 µg kg-1) infused i.v. over a 10 min period just before placing the patient on cardiopulmonary bypass.

Results. Perioperative haemodynamic variables, concentrations of cardiac troponin I over the 48 h postoperative period, and clinical outcomes were assessed. There were no adverse effects related to levosimendan. Compared with control patients, levosimendan-treated patients had lower postoperative troponin I concentrations (P<0.05) and a higher cardiac index (P<0.05).

Conclusion. Patients receiving a short infusion of levosimendan before CABG showed evidence of less myocardial damage, suggestive of a preconditioning effect. Larger outcome studies are thus indicated to confirm benefit.

Keywords: anaesthesia, cardiac; complications, myocardial infarction; heart, ischaemia; heart, myocardial function; muscle cardiac, contractility.
{dagger}Declaration of interest. M.S. has sat on advisory boards for levosimendan on behalf of Orion, the manufacturer, and Abbott, the distributor. He has also received honoraria for chairing/speaking at satellite symposia and for co-editing a website, failinghears.com, supported by an unrestricted educational grant from Abbott.
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E-letters:

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MIP: Many questions unanswered.
Dr Sumit Kumar Jha, et al.
British Journal of Anaesthesia, 18 May 2006 [Full text]
Re: MIP: Many questions unanswered.
Vincenzo De Santis
British Journal of Anaesthesia, 31 May 2006 [Full text]

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